Orange County NC Website
Browse       Search
DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON-DISCRIMINATION <br />CLAUSE <br />Are any of the Board Members or employees of the agency which will be carrying out this program or <br />members of their immediate families, or their business associates. <br />YES NO <br />☐X a)Employees of or closely related to employees of the Town of Carrboro,the Town of Chapel Hill, <br />or Orange County? <br />X ☐b)Members of or closely related to members of the governing bodies of the Town of Carrboro,the <br />Town of Chapel Hill, or Orange County? <br />☐ X c) Current beneficiaries of the program for which funds are being requested? <br />☐X d)Paid providers of goods or services to the program or having other financial interest in the <br />program? <br />If you have answered YES to any question,please provide a full explanation below. <br />We are thrilled that Tai Hyunh,a Chapel Hill Town Council Member,is Member on RCP’s Board of Directors. <br />Tai and RCP are conscious of potential conflicts of interest,and will take the necessary measures to mitigate <br />against them. <br />NON-DISCRIMINATION <br />Provider agrees as part of consideration of the granting of funds by funding agencies to the parties <br />hereto for themselves,their agents,officials,employees and servants agree not to discriminate in any <br />manner of these basis of race,color,gender,national origin,age,handicap,religion,sexual orientation, <br />gender identity/expression,familial status or veterans status with reference to any activities carried out <br />by the grantee,no matter how remote. The parties hereto further agree in all respects to conform to the <br />provision and intent of Orange County Civil Rights Ordinance,as amended and the Orange County <br />Anti-discrimination Policy. This provision is enforced by action for specific performance,injunctive relief, <br />or other remedy as by law provided;this provision shall be binding on the grantees,the successors and <br />assigns of the parties hereto with reference to the above subject manner. <br />To the best of my knowledge and belief all of the above information is true and current.I acknowledge <br />and understand that the existence of a potential conflict of interest does not necessarily make the <br />program ineligible for funding,but the existence of an undisclosed conflict may result in the <br />termination of any grant awarded. <br />Signature: <br />Executive Director Date <br />Signature: <br />Board Chairperson Date <br />Application Signatures: Please submit a wet signature or electronic signature,MS Word <br />cursive fonts are not acceptable. <br />Cover Page Page 8 of 21 <br />Vice Chair <br />January 12, 2023 <br />January 12, 2023 <br />DocuSign Envelope ID: C7E9E35D-4294-4C57-9D16-FD34B7245AA8